Frail elderly, nutritional status and drugs

A Study of Factors Contributing to the Nutritional Status of Elderly People Receiving Home Care

(1) Background: Nutrition is a critical aspect of health and well-being in the elderly population, as physiological changes associated with aging can impact nutrient utilization and dietary needs. The aim of this study was the assessment of nutritional screening and associated factors among community-dwelling elderly people. (2) Methods: This study is the first phase of an intervention trial of people aged 65 years and over who received primary health services and resided in the municipality of Archanes Asterousia in Crete, Greece. Nutritional risk was assessed using the Mini Nutritional Assessment. Diet-related factors were analyzed, including health status (oral hygiene, depression, cognitive decline, impaired functioning, quality of life), social factors (educational attainment, marital status, type of work before 60 years), and lifestyle factors (smoking, drinking, diet). (3) Results: A total of 730 elderly people were evaluated (males, 31.5%), with an average age (±SD) of 76.83 (±6.68) years. MNA was found to have a statistically significant connection with assessment of oral hygiene, mental state, Charlson comorbidity, functional independence (assessed with the Barthel scale), and quality of life. The exception was geriatric depression (GDS), with which no statistically significant association was found (p > 0.05). Nutritional risk analysis revealed 379 participants (51.9%) to be adequately nourished, 205 (28.1%) to be at risk of malnutrition, and 146 (20.0%) to be malnourished. (4) Conclusions: These results clearly demonstrated the key factors that contribute to the nutritional screening of elderly people and need to be addressed by health authorities and social services.

Age- and sex-matched comparison of diet quality in patients with heart failure to similarly aged healthy older adults

The aims of this study were to (1) compare diet quality between patients with heart failure (HF) and age- and sex-matched community-dwelling healthy older adults and (2) determine whether having HF was associated with a lower Healthy Eating Index-2015 (HEI-2015) score and risk of micronutrient deficiency. The HEI-2015 and macro- and micronutrient intakes of patients with HF were compared with healthy older adults (N 102; 55-92 years old; 53 % female). A paired t-test or Wilcoxon singed-rank test, McNemar's test, and conditional logistic regression were used to assess the association between diet quality and HF status. Median values for HEI-2015 and the number of micronutrient deficiency were used to dichotomise into groups in the conditional logistic regression. There was no significant between-group difference in the HEI-2015 total score (P 0⋅059), whereas the whole grain component was lower in patients with HF than in healthy older adults (3⋅1 ± 3⋅5 v. 4⋅5 ± 3⋅1, P 0⋅037; respectively). Total caloric intake was lower in patients with HF than in healthy older adults (1683 ± 595 v. 2104 ± 670 kcal; P < 0⋅001). Patients with HF had a higher average number of micronutrient deficiencies than healthy older adults (4[2, 6] v. 1[0, 4], respectively, P < 0⋅001). Patients with HF had four times higher odds of being in a high micronutrient deficiency group than healthy older adults, controlling for socio-demographics and body mass index (adjusted odds ratio [95 % confidence interval]: 4⋅04[1⋅06, 15⋅41]). Our findings demonstrate that diet quality measured by nutritional intake identifies patients with HF with lower caloric intake and higher micronutrient deficiencies compared with age- and sex-matched healthy older adults.

Risk Factors for Malnutrition in Older Adults: A Systematic Review of the Literature Based on Longitudinal Data

The present systematic review critically examines the available scientific literature on risk factors for malnutrition in the older population (aged ≥65 y). A systematic search was conducted in MEDLINE, reviewing reference lists from 2000 until March 2015. The 2499 papers identified were subjected to inclusion criteria that evaluated the study quality according to items from validated guidelines. Only papers that provided information on a variable's effect on the development of malnutrition, which requires longitudinal data, were included. A total of 6 longitudinal studies met the inclusion criteria and were included in the systematic review. These studies reported the following significant risk factors for malnutrition: age (OR: 1.038; P = 0.045), frailty in institutionalized persons (β: 0.22; P = 0.036), excessive polypharmacy (β: -0.62; P = 0.001), general health decline including physical function (OR: 1.793; P = 0.008), Parkinson disease (OR: 2.450; P = 0.047), constipation (OR: 2.490; P = 0.015), poor (OR: 3.30; P value not given) or moderate (β: -0.27; P = 0.016) self-reported health status, cognitive decline (OR: 1.844; P = 0.001), dementia (OR: 2.139; P = 0.001), eating dependencies (OR: 2.257; P = 0.001), loss of interest in life (β: -0.58; P = 0.017), poor appetite (β: -1.52; P = 0.000), basal oral dysphagia (OR: 2.72; P = 0.010), signs of impaired efficacy of swallowing (OR: 2.73; P = 0.015), and institutionalization (β: -1.89; P < 0.001). These risk factors for malnutrition in older adults may be considered by health care professionals when developing new integrated assessment instruments to identify older adults' risk of malnutrition and to support the development of preventive and treatment strategies.

Nutritional status in community-dwelling elderly in France in urban and rural areas

Malnutrition is a frequent condition in elderly people, especially in nursing homes and geriatric wards. Its frequency is less well known among elderly living at home. The objective of this study was to describe the nutritional status evaluated by the Mini Nutritional Assessment (MNA) of elderly community-dwellers living in rural and urban areas in France and to investigate its associated factors.

Methods

Subjects aged 65 years and over from the Approche Multidisciplinaire Intégrée (AMI) cohort (692 subjects living in a rural area) and the Three-City (3C) cohort (8,691 subjects living in three large urban zones) were included. A proxy version of the MNA was reconstructed using available data from the AMI cohort. Sensitivity and specificity were used to evaluate the agreement between the proxy version and the standard version in AMI. The proxy MNA was computed in both cohorts to evaluate the frequency of poor nutritional status. Factors associated with this state were investigated in each cohort separately.

Results

In the rural sample, 38.0% were females and the mean age was 75.5 years. In the urban sample, 60.3% were females and the mean age was 74.1 years. Among subjects in living in the rural sample, 7.4% were in poor nutritional status while the proportion was 18.5% in the urban sample. Female gender, older age, being widowed, a low educational level, low income, low body mass index, being demented, having a depressive symptomatology, a loss of autonomy and an intake of more than 3 drugs appeared to be independently associated with poor nutritional status.

Conclusion

Poor nutritional status was commonly observed among elderly people living at home in both rural and urban areas. The associated factors should be further considered for targeting particularly vulnerable individuals.

Preventing malnutrition in home-dwelling elderly individuals

The aim of this article is to provide an overview of the role of the nurse in the identification and prevention of malnutrition in home dwelling elderly individuals. It will examine the causes and prevalence of malnutrition outlining the factors that may place older home-dwelling people at risk of developing this serious nutritional disorder. The remainder of the article will provide an in-depth focussed discussion on the role of the community nurse in the assessment and prevention of malnutrition, with recommendations for the improvement of clinical practice.

Nutritional status in the oldest elderly and associated factors

OBJECTIVE

To verify factors associated with nutritional status in an oldest elderly communitydwelling population in Southern Brazil.

METHODS

This cross-sectional epidemiological and household-based study involved all subjects (n = 134) aged > 80 years who were living in Antônio Carlos (Santa Catarina state, Brazil). Nutritional status was assessed by body mass index (BMI < 22.0 kg/m², underweight; BMI > 27.0 kg/m², overweight). Explanatory variables in the study were: gender (women/ men), literacy (knows how to write and read - yes/no), living conditions (lives alone/with company), cognitive function (normal/altered), eating difficulty (yes/no), medication use (none to two/three or more), morbidity (none to two/three or more diseases), alimentary pattern (adequate/inadequate), alcohol consumption (none to one day a week, two or more days a week), cigarette smoking (never/current or former smoker), physical activity level (< 150 min/week; > 150 min/week), and sitting time (< 4 hours/day; > 4 hours but < 6 hours/ day; > 6 hours/day).

RESULTS

Prevalence of underweight was 27.3% in men and 12.8% in women (p < 0.01), and was positively associated with altered cognitive function (OR: 3.52) and inversely related with greater medication use (OR: 0.34). Overweight affected 25.5% of men and 53.8% of women. It was negatively associated with illiteracy (OR: 0.12) and positively associated with female gender (OR: 2.58).

CONCLUSION

There are differences between men and women regarding nutritional status. The factors associated to nutritional status of the oldest elderly from Antônio Carlos are specific to the vulnerability condition (underweight and overweight).

Riscos da interação droga-nutriente em idosos de instituição de longa permanência

O objetivo do estudo foi verificar riscos da interação droga-nutriente nos idosos residentes em Instituição de Longa Permanência. Trata-se de estudo descritivo, de abordagem quantitativa, realizado em 73 idosos. A coleta dos dados ocorreu em 2008, através da análise dos prontuários, história dietética e avaliação do IMC. Os dados evidenciaram que os medicamentos mais utilizados foram do sistema nervoso e cardiovascular, totalizando 66% das prescrições. Entre 375 medicamentos prescritos, 166 fazem algum tipo de interação, 32,0% diminuem o efeito de absorção do fármaco quando há utilização de cafeína e 14,3% diminuem absorção de vitamina B12. A utilização de diversos medicamentos de uso contínuo pode acarretar prejuízo na absorção de nutrientes, aumentando o risco de desnutrição em idosos. Torna-se indispensável a ação da equipe de saúde, através da avaliação criteriosa dos medicamentos administrados, dietoterapia e a interação entre os mesmos, para beneficiar idosos com melhor aproveitamento da terapêutica e melhoria das condições nutricionais.

Lessons learned from the first wave of aging with HIV

In this perspective piece, the authors consider what has been learned and is being studied about aging with HIV in resource-rich settings. The authors argue that although there is much that will be different about aging with HIV in other parts of the globe, there are common themes and approaches to care. These include the observation that most patients have more than one health condition, and the need to assess individual risk, prioritize care, and consider the total burden of disease when considering further testing and treatment.

Therapeutic paracetamol treatment in older persons induces dietary and metabolic modifications related to sulfur amino acids

Sulfur amino acids are determinant for the detoxification of paracetamol (N-acetyl-p-aminophenol) through sulfate and glutathione conjugations. Long-term paracetamol treatment is common in the elderly, despite a potential cysteine/glutathione deficiency. Detoxification could occur at the expense of anti-oxidative defenses and whole body protein stores in elderly. We tested how older persons satisfy the extra demand in sulfur amino acids induced by long-term paracetamol treatment, focusing on metabolic and nutritional aspects. Effects of 3 g/day paracetamol for 14 days on fasting blood glutathione, plasma amino acids and sulfate, urinary paracetamol metabolites, and urinary metabolomic were studied in independently living older persons (five women, five men, mean (±SEM) age 74 ± 1 years). Dietary intakes were recorded before and at the end of the treatment and ingested sulfur amino acids were evaluated. Fasting blood glutathione, plasma amino acids, and sulfate were unchanged. Urinary nitrogen excretion supported a preservation of whole body proteins, but large-scale urinary metabolomic analysis revealed an oxidation of some sulfur-containing compounds. Dietary protein intake was 13% higher at the end than before paracetamol treatment. Final sulfur amino acid intake reached 37 mg/kg/day. The increase in sulfur amino acid intake corresponded to half of the sulfur excreted in urinary paracetamol conjugates. In conclusion, older persons accommodated to long-term paracetamol treatment by increasing dietary protein intake without any mobilization of body proteins, but with decreased anti-oxidative defenses. The extra demand in sulfur amino acids led to a consumption far above the corresponding population-safe recommendation.

Polypharmacy and nutritional status in elderly people

PURPOSE OF REVIEW

Increasing use of drugs among elderly people has raised concerns about possible negative health outcomes, including malnutrition, associated with polypharmacy. Evidence about the association of polypharmacy with nutritional status is scarce. This review summarizes the relevant evidence regarding polypharmacy and nutritional status in elderly people.

RECENT FINDINGS

The probability of nutritional problems as a consequence of drugs is highest in elderly people suffering from several diseases. Drug treatment may contribute to poor nutritional status by causing loss of appetite, gastrointestinal problems, and other alterations in body function. Some recently published studies add evidence on possible association between increasing number of drugs and malnutrition. Studies indicate also an association between polypharmacy and weight changes. In addition, there are available studies that have shown deficits in the intake of specific macronutrients and micronutrients (e.g. fiber, glucose, and specific vitamins) for those with a high number of drugs in use.

SUMMARY

On the basis of available evidence, the role of polypharmacy on nutritional status among elderly people is unclear. Some diseases promote malnutrition; thus, the independent role of drugs for nutritional status is challenging to determine. Longitudinal studies with careful adjustment for underlying diseases are needed to explore association between polypharmacy and malnutrition. Nutritional evaluation should be a routine part of comprehensive geriatric assessment that is conducted ideally in multiprofessional teams, including physician, pharmacist, and dietitian.

Chronic pain in later life: a review of current issues and challenges

The effects of aging present a major medical challenge in the 21st century, which will cause fundamental changes in demography. By 2031, it is estimated that 22% of the UK population will be aged over 65 years, and there will be more people in this age group than aged under 25 years. As well as implications for infrastructure and productivity, this change will alter the prevalence and impact of many illnesses and pathologies. The research priorities of many of the major funding bodies reflect this challenge. The Medical Research Council in the UK, for example, leads the Lifelong Health and Wellbeing program on behalf of all the country’s research councils. This initiative aims to identify factors that affect or improve health in later life, to inform relevant policy and practice. The Wellcome Trust lists the investigation of development, aging and chronic disease as one of its five major research challenges, and the European Commission presents the health of the aging population as one of its three overarching issues of the Health Theme in its 7th Framework Program of research. Chronic pain is a major health condition associated with aging, whose management (pharmacological and nonpharmacological) is generally unsatisfactory. The International Association for the Study of Pain designated 2006/07 as its Global Year Against Pain in Older Adults. This article reviews the relevance of existing and potential research on the assessment and management of chronic pain in older adults.

Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population

PURPOSE

To determine the association of polypharmacy with nutritional status, functional ability and cognitive capacity among elderly persons.

METHODS

This was a prospective cohort study of 294 survivors from the population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) Study, with yearly follow-ups during 2004 to 2007. Participants were the citizens of Kuopio, Finland, aged 75 years and older at baseline. Polypharmacy status was categorized as non-polypharmacy (0-5 drugs), polypharmacy (6-9 drugs) and excessive polypharmacy (10+ drugs). A linear mixed model approach was used for analysis the impact of polypharmacy on short form of mini nutritional assessment (MNA-SF), instrumental activities of daily living (IADL) and mini-mental status examination (MMSE) scores.

RESULTS

Excessive polypharmacy was associated with declined nutritional status (p = 0.001), functional ability (p < 0.001) and cognitive capacity (p < 0.001) when compared to non-polypharmacy group. Age, institutional living, poor self-reported health and time of measuring were also associated with the three outcome measures. In the excessive polypharmacy group, the proportion of malnourished or at risk of it increased from 31% to 50%, having difficulties in daily tasks from 48% to 74% and impaired cognition from 36% to 54% during the follow-up. The mixed model analysis revealed that polypharmacy status was not able to predict the progress of MNA-SF, IADL and MMSE scores over a three-year time.

CONCLUSIONS

Excessive polypharmacy is associated with decline in nutritional status, functional ability and cognitive capacity in elderly persons. However, the changes in nutrition, physical functionality and cognition over a three-year period cannot be predicted by polypharmacy status.

A composite screening tool for medication reviews of outpatients: general issues with specific examples

Regular performance of medication reviews is prominent among methods that have been advocated to reduce the extent and seriousness of drug-related problems, such as adverse drug reactions, drug-disease interactions, drug-drug interactions, drug ineffectiveness and cost ineffectiveness. Several screening tools have been developed to guide practising healthcare professionals and researchers in reviewing the medication patterns of elderly patients; however, each of these tools has its own limitations. This review discusses a wide range of general prescription-, treatment- and patient-related issues that should be taken into account when reviewing medication patterns by implicit screening. These include generic and therapeutic substitution; potentially superfluous or inappropriate medications; potentially inappropriate dosages or duration of treatment; drug-disease and drug-drug interactions; under-treatment; making use of laboratory test results; patient adherence, experiences and habits; appropriate dosage forms and packaging. A broad selection of specific examples and references that can be used as a basis for explicit screening of medication patterns in outpatients is also offered.

Nutrition and geriatric psychiatry: a neglected field

PURPOSE OF REVIEW

Nutritional issues have received little attention in geriatric psychiatry research. This review focuses on literature published in 2003 and 2004 on nutritional factors in mental illness in the elderly and proposes directions for future research.

RECENT FINDINGS

There has been more research on the role of micronutrients in psychiatric disorders of older adults but studies examining nutritional state in this population are lacking. The former research suggests associations between low folic acid/vitamin B12 status and depression in older adults whereas evidence for other micronutrients is still tentative. In the latter work, there is only one study that examines malnutrition in psychogeriatric patients despite the availability of well-validated screening tools for assessing nutritional state in the elderly and the known impact of undernutrition in ageing and the development of frailty. The role of obesity in ageing is also relevant especially as more people with schizophrenia live longer, although the current evidence in the non-mentally ill elderly suggests that being overweight may have protective effects in the elderly.

SUMMARY

Malnutrition is likely to have considerable impact on the mental and physical state of the elderly.